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Your Back or Neck Hurts—What Can You Do?

Lots of people in pain go to chiropractors and acupuncturists. In a large survey of muscle pain patients at Kaiser Permanente Northwest, a health maintenance organization serving about 500,000 members in Oregon and Washington, 32 percent said they had tried acupuncture, and 47 percent had seen a chiropractor — less than half had used neither. But many did not tell their primary care doctor.

Why wouldn’t you tell your doctor what you were doing? You may have felt there wasn’t time. You may have waited for your doctor to ask you. Or you might worry that your doctor would be unsympathetic to alternative treatments and try to talk you into stopping.

Here's a good answer: It gives me temporary relief. “All placebos are not equal – an elaborate system involving lying down, relaxing, and spending time with a caring authority can be expected to produce a much greater placebo effect than simply taking a sugar pill,” explains Harriet Hall, a retired family doctor who writes about false medical claims at ScienceBasedMedicine.org (link is external). Embrace the placebo that works for you.

Just don't fall for hype and overspend, hoping for a cure of the underlying cause of your pain. I've had chiropractics and massage practitioners tell me they could change my posture or make me less anxious. Don't count on it.

By definition, “alternative” medicine covers treatments that don’t have much or any scientific backing or are not widely accepted by doctors. The evidence for acupuncture and chiropractic isn’t impressive. A review (link is external)of the scientific literature found that acupuncture for chronic general low back pain beats placebo, but the relief is short-term. Chiropractic has better results than acupuncture for low back pain patients, but again only for temporary relief. Massage also helps, briefly: in this review, it turned out to be superior to placebo or no treatment for low back pain.

Most of what you’ve heard about acupuncture is wrong, writes (link is external)Hall. Acupuncture is usually described as an ancient Chinese treatment, but it doesn’t appear to be ancient and may not even be Chinese! The first accounts of Chinese medicine that reached the West in the 13th century didn’t mention acupuncture. You may have heard your acupuncturist talk about “meridians” and use the word “qi” for “energy.” According to Hall, that language was made up by a Frenchman, Georges Soulie de Morant, in 1939. Chinese people are much less interested in acupuncture than Westerners are. There are plenty of reasons why acupuncture could make you feel better, temporarily: your attention is diverted, you want to trust the acupuncturist or find her likable, or maybe you want to believe you are spending your money well.

When researchers have applied electrical current to the skin of the wrist, they obtained just as good results as when inserting needles. It appears not to matter where the needle is inserted.

What about chiropractic? There is some evidence that manipulations can help low back pain, but no back-up for chiropractic theory or the claims that chiropractic can help a host of other problems. (link is external)

Should you try massage instead? Massage may make you feel better, but again, don’t fall for the pseudoscience. Avoid “structural” massage, which is generally painful and no more effective than a relaxing massage (link is external). Too much pressure can make you more tense and even feel like you have a flu, explains Paul Ingraham, the author of PainScience.com (link is external), an assistant editor at ScienceBasedMedicine.org, (link is external) and a registered massage therapist who specialized in difficult chronic pain cases for a decade. In one study (link is external) in which researchers called 91 massage therapy clients after their session, 10 percent reported “minor discomfort.” Most of them said it came on within a day and was gone within three. Show anyone giving you a massage how much pressure you like, and tell them to back off if they dig too hard, Ingraham advises.

If you regularly sleep better in hotels, on the sofa, or in your recliner, consider buying a new mattress. Sleeping poorly increases sensitivity to pain. You’ll need to pick your new mattress carefully; for tips see my story, “Rest for Your Aching Back." (link is external)

If you're seeing a doctor for your pain, tell him or her what you’re doing. Being heard out and receiving feedback and advice can help quell your anxiety, which is soothing in itself.

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